What are the responsibilities and job description for the Denials and Appeals Analyst position at Singing River Health System?
Denials and Appeals Analyst Education Physical Demands
Singing River Health System Administrative Building - Gautier | Full-Time | Monday-Friday 8:00am-4:30pm |
Mississippi
United States
Position Overview
The Denials and Appeals Analyst assists in the recovery of Health System revenue by bringing denied claims to full resolution. He/She works collaboratively with departmental peers throughout the System to achieve departmental and system-wide quality, satisfaction, and financial goals.
The Denials and Appeals Analyst coordinates the appeals process for denials deemed appropriate by the Patient Financial Services Director and the Denials Manager. He/She assures that prompt action is taken on assigned denials by coordinating with clinical staff to create written and/or verbal clinical appeals with payers. The Analyst works closely with third party payors, Managed Care representatives, insurance billing staff, case management, and other service departments to resolve denied claims. He/She is a liaison and communicates denials related information and knowledge to Organizational Leaders.
DISCLAIMER: This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this is intended to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks be performed as assigned.
High School Diploma or equivalent required; Associate’s degree preferred.
License
N/A
Certification
Epic certification in Resolute Hospital Billing and/or Certified Coding Specialist preferred.
Experience
A minimum of five (5) years’ patient accounting and insurance experience required. Experience in a hospital and/or physician office preferred.
Work is moderately active: involves sitting with frequent requirements to move about the office move about the facility, and to travel to another facility within the SRHS service area. Work involves exerting a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Work involves using repetitive motions: substantial movements of the wrists, hands and/or fingers while operating standard office equipment such as computer keyboard copier and 10-key.
Work involves being able to perceive the nature of sound at normal speaking levels with or without correction; the ability to make fine discriminations in sound. Work requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms/printed material that are closer to compare data at close vision.
Must be able to be active for extended periods of time without experiencing undue fatigue. Must be able to work flexible hours.
Mental Demands
Must demonstrate keen mental faculties/assessment and decision making abilities. Must demonstrate superior communication/speaking/enunciation skills to receive and give information in person and by telephone. Must demonstrate strong written communication skills. Must possess emotional stability conducive to dealing with high stress levels.
Must demonstrate ability to work under pressure and meet deadline. Attention to detail and the ability to multi-task in complex situations is required. Must demonstrate the ability to solve problems independently and as part of a team.
Must possess knowledge of medical terminology. Must have an understanding of Revenue Cycle functions in a hospital setting. Knowledge of Medicare, Medicaid, and insurance billing / reimbursement is required.
Special Demands
Must possess superior customer service skills and professional etiquette. Must possess proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.). Must have intermediate knowledge of MS Outlook, Word, Excel, and PowerPoint.
Must possess strong communication and interpersonal skills with the ability to facilitate process change and build positive relationships across multiple clinical and administrative areas. Work requires the ability to function independently, adapt to workload demands, set priorities, and understand and set goals. Must understand the fundamentals of automated data processing, and be able to quickly gain a detailed understanding of complex computerized and non-computerized information.
Job may require traveling throughout the SRHS service area - with the employee providing his/her own transportation. Must have a valid driver's license. Travel for education purposes may be required.
